Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Mar 2006
ReviewUltrasound lung comets: a clinically useful sign of extravascular lung water.
Assessment of extravascular lung water is a challenging task for the clinical cardiologist and an elusive target for the echocardiographer. Today chest x-ray is considered the best way to assess extravascular lung water objectively, but this requires radiology facilities and specific reading expertise, uses ionizing energy, and poses a significant logistic burden. Recently, a new method was developed using echocardiography (with cardiac probes) of the lung. ⋯ Functionally, ULCs are a sign of distress of the alveolar-capillary membrane, often associated with reduced ejection fraction and increased pulmonary wedge pressure. The ULC sign is quantitative, reproducible, and ideally suited to complement conventional echocardiography in the evaluation of heart failure patients in the emergency department (for the differential diagnosis of dyspnea), in-hospital evaluation (for tailoring diuretic therapy), home care (with portable ultrasound), and stress echocardiography lab (as a sign of acute pulmonary congestion during stress). In conclusion, ULCs represent a useful, practical, and appealingly simple way to image directly extravascular lung water.
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J Am Soc Echocardiogr · Mar 2006
Comparative Study Controlled Clinical TrialComparison of contrast-enhanced real-time live 3-dimensional dobutamine stress echocardiography with contrast 2-dimensional echocardiography for detecting stress-induced wall-motion abnormalities.
Two-dimensional (2D) contrast-enhanced dobutamine stress echocardiography (DSE) is used clinically to diagnose stress-induced wall-motion abnormality (WMA). We hypothesized that contrast-enhanced real-time 3-dimensional (3D) DSE could improve the detection rate of WMA, because from a single full-volume acquisition, multiple segments can be visualized. ⋯ Contrast-enhanced 3D DSE was feasible in the majority of patients. However, the moderate concordance between both modalities was a result of: (1) difficulties in visualizing the anterolateral segments because of the relatively large imprint of the transducer; and (2) lower frame rates with 3D DSE resulting in the erroneous diagnosis of dyssynchrony.
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J Am Soc Echocardiogr · Mar 2006
Case ReportsThree-dimensional transesophageal echocardiography in the evaluation of aortic valve destruction by endocarditis.
Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. The aim of this study was to demonstrate the clinical usefulness of 3-dimensional transesophageal echocardiography for the spatial assessment of aortic valve endocarditis. This case showed severe destruction of the aortic valve with perforations by endocarditis.
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J Am Soc Echocardiogr · Mar 2006
Case ReportsLeft ventricular outflow tract obstruction caused by accessory mitral valve tissue.
This report describes the echocardiographic diagnosis of accessory mitral valve tissue causing left ventricular outflow tract obstruction in a symptomatic man. The accessory tissue was surgically removed and the mitral valve replaced with complete resolution of left ventricular outflow tract gradient and symptoms. The case illustrates the importance of transthoracic and transesophageal echocardiography in the diagnosis and preoperative evaluation of this rare but treatable cause of subaortic valve obstruction.
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J Am Soc Echocardiogr · Mar 2006
Case ReportsRapid ventricular remodeling with left ventricular unloading postventricular assist device placement: new insights with strain imaging.
We report the case of a 6-year old girl who presented with severe dilated cardiomyopathy. Cross-sectional echocardiography demonstrated a severely dilated hypokinetic left ventricle with an ejection fraction less than 10%. ⋯ Within 1 week of mechanical support, echocardiography demonstrated dramatic reverse remodeling of the left ventricle with marked improvement in myocardial deformation using strain rate imaging. This report further highlights the potential for rapid remodeling after mechanical support of the failing myocardium.